骨髓增生异常综合征巨核细胞增殖与凋亡的初步研究

Study about Proliferation and Apoptosis of Megakaryocytes in Patients with Myelodysplastic Syndromes

为观察骨髓增生异常综合征 (MDS)巨核系细胞增殖与凋亡状况 ,用CD4 1免疫酶标 (APAAP)结合DNA末端原位标记 (ISEL) ,分析 2 9例MDS患者骨髓塑料冷包埋切片中巨核细胞的增生状况、凋亡数量及特征 ,并以缺铁性贫血 14例作为对照。结果显示 ,2 9例MDS之CD4 1阳性细胞数平均为 (2 6 .2 3± 18.18)个 /毫米2 ,对照组 (15 .6 4± 7.11)个 /毫米2 ,t′2 .5 4 ,P <0 .0 5 ;MDS病例微小巨核细胞明显增多 ,占巨核细胞总数的 31.2 0 % ,对照组仅12 .0 1% ,P <0 .0 1。MDS巨核细胞总数与微小巨核细胞数之间显示正相关 ,r值 0 .70 2 ,P <0 .0 1。MDS之巨核细胞且出现在骨小梁旁的异常分布及成簇现象。MDS巨核系细胞凋亡仅占该系细胞的 4 .4 0 % ;占凋亡细胞总数的9.32 % ,与对照组相比无显著差异。MDS巨核系细胞凋亡仅见于微小巨核细胞 ,且与微小巨核细胞数间存在正相关 (r =0 .5 89) ,但部分显示微小巨核细胞形态学特征的凋亡细胞不表达CD4 1。结论认为 ,MDS确实存在巨核细胞过度增殖及明显病态 ,微小巨核细胞凋亡可能系机体对异常增殖的生理反应 ,未观察到巨核细胞凋亡明显增加可能与晚期凋亡细胞不表达CD4

In order to observe the proliferative and apoptotic situation of megakaryocytes in patients with myelodysplastic syndromes(MDS). CD41 immunoenzyme labelling(alkaline phosphatase anti alkaline phosphatase APAAP)/DNA in situ end labelling(ISEL) double stained techniques was used onto plastic cold embedded bone marrow sections in 29 MDS patients to analyse the proliferative and apoptostic characterization of megakaryocytic line with 14 cases of iron deficient diseases(IDA) as control. The results showed that the mean CD41 positive cell number in MDS group was (26.23±18.18) /mm 2 with a count of (15.64±7.11) /mm 2 in control group(P<0.05). The small micro megakaryocytes in MDS is much higher than that in IDA group(P<0.01). There was a positive co relation between total megakaryocytes and small micro megakaryocytes count in MDS (r=0.702, P<0.01). Some megakaryocytes distributed abnormally around trabecula and formed small or large clusters. Apoptotic megakaryocytes in MDS ocupied 4.40% and 9.32% of all CD14 positive cells and all apoptotic cells respectively (P>0.5 comparing with contral). Apoptosis in megakargocytic line occurred only in small micro megakaryocytes and showed positive co relation to the number of micro megakaryocytes. Some apoptotic cell with morphologic characters of megakaryocytes expressed no CD41. It is concluded that overproliferation of megakaryocytes exists in MDS. Apoptosis occuring in micro megakaryocytes may be a kind of physiological response to abnormal megakaryopoicsis in MDS. No obvious increased apoptosis of megakaryocytes in MDS was found perhaps due to lack of surface antigens CD41 in some later stages of apoptotic cells.